PNC's 5010 Readiness Testing

To help providers, payers and trading partners prepare for the new healthcare transaction standards that go into effect January 1, 2012, PNC has started full-scale Level II 5010 readiness testing.

Provider testing will be scheduled from April through December 2011. PNC will also be concurrently testing with payers, independent of provider testing, to determine whether all payer required 5010 testing processes are passed and completed.

If you have any questions regarding the testing process, please email them to pncha@pnc.com. A PNC representative will reach out promptly to answer any questions.

835 Remittance Test File

PNC has created a 835 Remittance test file that providers can use to process through their billing system to determine 5010 version and production readiness. To download the file, click here.

The test file contains 4010 835 remittance data that has been converted to a 5010A1 remittance to allow providers to test their systems to determine readiness to receive a PNC 5010A1 version 835 remittance. The data has been de-identified.

What will the file test?

The 5010A1 835 version testing file includes 136 different claims in a number of different scenario combinations. These combinations include a variety of ISA/IEA, GS/GE, and ST/SE combinations. The test file includes examples with 15 Interchanges (ISA/IEA), 16 groups (GS/GE), and 29 transactions/payments (ST/BPR/SE). For more specific information, click here.

Are there benefits to using PNC's test file rather than another test file?

Typically, de-identifying the data changes all information to the same value (all patients become the one single patient; all providers become one single provider, etc.).

PNC's test file, while de-identified, maintains separate values (each patient remains separate under a generic name and ID, each provider remain separate under a generic name and ID, etc.). This allows the test file to be more "realistic", albeit with fictional names and ID numbers.* The changed and de-identified data may cause the test file to not properly validate within your billing system. But the test file should be used to test acceptance of the 5010A1 format not the data content.

The file will validate to the following levels without rejecting under Edifecs validation:

  • Level 1 X12
  • Level 2 HIPAA
  • Level 3 Balancing

*The testing file will have issues when evaluated at levels 4-7, but that is expected when you alter IDs to "fictional/de-identified" values.

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